Solitary giant neurofibroma of the neck subjected to photodynamic therapy: case study

Abstract

Photodynamic therapy (PDT) - the fourth modality - has been successfully used in the management of early and advanced pathologies of the head and neck. We studied the effect of this modality on a giant solitary neurofibroma of the neck. A 70-year-old Caucasian female presented with left neck pain and disfigurement associated with slight shortness of breath and dysphagia. Examination revealed a large mass in the neck with no neurovascular compromise. Magnetic resonance imaging (MRI) reported a heterogeneously enhancing mass extending from the left angle of the mandible to the base of the neck. A core biopsy was performed and histopathological examination revealed a disorganised array of peripheral nerve fascicles. The patient elected to receive photodynamic therapy as the primary intervention. The multi-disciplinary meeting approved the treatment plan. The photosensitizing agent was mTHPC (0.15 mg/kg), which was systemically administered 96-hours prior to ultrasound (US)-guided light delivery to the mass, which was undertaken under general anaesthesia. Recovery was uneventful.Post-PDT follow-up showed that the patient’s pain, dysphagia and shortness of breath issues had improved. The disfigurement of the neck caused by the mass was no longer a problem. Three months post-PDT, MRI revealed a significant reduction in the neurofibroma size. PDT was proven as a successful primary intervention for this pathology. However, higher evidence-based studies are required before this therapy can be proposed as a replacement to any of the other conventional therapies.

Solitary isolated neurofibroma of the soft palate

“…Neurofibroma is an uncommon benign neoplasm which originates from nerves that is composed of Schwann cells, perineural cells and fibroblasts. Soft palatal neurofibromas are rare and present with slowly growing painless mass [2]. Generally, neurofibromas present as either solitary mass or as part of neurofibromatosis syndrome or von Recklinghausen’s disease [3].…”

A Solitary Giant Neurofibroma of Inguinal Region—A Case Report

“…Neuro broma is a rare benign nerve sheath tumor composed of Schwann cells, perineural like cells and broblasts (10). It can be found in any peripheral nerve that can be invaded by neuro broma, especially in lower limbs and upper limbs (2).…”

“…But biopsy has a risk of causing nerve damage, which is likely to occur in this case as intraoperatively, we found that some of the nerve ber tracts were extruded particularly thinly by the tumor. At present, the rst choice of clinical treatment for neuro bromas is still complete resection, especially when symptoms occur or appearance are affected, the postoperative prognosis is good and the recurrence rate is low (2,10). However, the parent nerve of neuro bromas is usually unseparable in solitary neuro bromas (6).…”

“…Radiotherapy is also a feasible method, but it is only suitable for isolated lesions to control or reduce the growth of lesions, and it is effective for the treatment of juvenile angio broma (19). Recently, there is also a literature showing that photodynamic therapy is effective for solitary neuro broma, but its long-term survival rate and long-term prognosis still need to be investigated (10).…”

Solitary vallecular neurofibroma presenting with respiratory obstruction: an unusual presentation

“…Neurofibroma is a benign nerve sheath tumour in the peripheral nervous system, constituting about 5% of all the benign soft-tissue neoplasms in the body originating from the Schwann cells or the perineural fibroblast cells 1. Patents in the third decade of life are mostly affected by the disease and there is no significant sex predilection between the males and the females 2.…”